From
StayCurrentMD
Rectal Prolapse Rapid Fire: Update Course 2015
With CCHMC Pediatric Surgery
Part of
Rectal Prolapse 5 items
Chapter 1 of 3 · Diagnosis & Workup
Workup & medical Rx
Diagnostic workup and medical management of rectal prolapse
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Rectal prolapse in the pediatric population has a limited literature base with room for improvement.
Full-thickness prolapse must be distinguished from partial-thickness (mucosal) prolapse.
The speaker was trained to test for CF in rectal prolapse patients and answered board questions accordingly, but has never picked up a CF case through this workup in practice.
Many practitioners have not picked up CF cases through rectal prolapse workup, though CF patients may present with prolapse.
Medical management for rectal prolapse includes treating constipation and limiting toilet sitting time to 5 minutes.
The speaker performs resection and Ripstein rectopexy for rectal prolapse.
Anal cerclage works well especially in small babies with rectal prolapse.
Laparoscopic rectopexy to the promontory is performed, with resection if there is a huge redundant segment.
Re-operating on patients after sclerosing agent injection is difficult.
The speaker has not had success with sclerosing agents and cannot recall a patient who did not ultimately require rectopexy.
The speaker has one patient operated on twice abdominally who then underwent ventral mesh rectopexy, which has solved the problem so far.
Transabdominal approaches for rectal prolapse have about a 5% recurrence rate.
Transanal approaches (transanal pull-through or Altmeyer procedure) have a recurrence rate between 15 and 20%.
Resection-rectopexy may be a better procedure for patients with refractory constipation.
Resection-rectopexy has a higher complication rate than rectopexy alone.
Patients can go home the next day or even same day after rectopexy according to recent literature.
Ventral mesh rectopexy is a newer procedure popularized by the Cleveland Clinic and other centers in adult literature.
Ventral mesh rectopexy involves placing mesh on the anterior surface of the rectum, elevating the rectum without posterior dissection, and tacking the mesh to the sacral promontory.
There are reports of mesh erosion in the pediatric population, making surgeons cautious about using mesh.
Ventral mesh rectopexy can be performed open or laparoscopically.
The pathophysiology of rectal prolapse in younger patients involves a straighter angle between rectum and anal canal, which becomes more acute with age.
Ventral mesh rectopexy is primarily used in older adult women with pelvic floor relaxation issues.